Heart and Circulatory SystemValve Replacement and Repair

Valve Replacement and Repair

For First and Second Class Special Issuance, there is a mandatory six-month recovery and stabilization period after a cardiac valve replacement. However, if the procedure involved a valve repair only, the recovery period is 90 days.

For Third Class special issuance consideration, however, there is no required wait time for either valve replacement or repair as a result of the BasicMed regulations that went into effect in May, 2017.

The FAA now allows mitral valve repair under the CACI (Conditions AMEs Can Issue) certification policy that will allow the AME to issue a normal duration medical certification provided all requirements on the worksheet are met.

The FAA also will consider special issuances for single and multiple valve replacements. Multiple valve replacement cases and any valve replacement involving application for first or second-class certification will be reviewed by the FAA Cardiology Panel. However, cases involving a Ross procedure, in which the aortic valve is replaced with the patient’s own pulmonic valve and the pulmonic valve is then replaced with a bioprosthesis is not considered a “multiple valve” procedure and may be evaluated for a special issuance medical certification by the FAA staff physicians.

Transcatheter Aortic Valve Replacement (TAVR), a relatively new non-invasive alternative to conventional aortic valve replacement, is also allowed for special issuance consideration following the same guidelines outlined below.

For special issuance consideration for all medical certification classes, you will need the following information:

Blood lipid profile, including total cholesterol, HDL, LDL, triglycerides, and plasma glucose level. If on Coumadin (warfarin), include confirmation of stability without complications, dosing history and schedule, and INR (International Normalized Ratio) accomplished at least monthly during the past six-months of observation. For medical certification purposes, the FAA wants to see that at least 80% of the total number of INR reports are within acceptable therapeutic range. For bioprosthetic (tissue) valve replacement or repair, INR readings should be between 2.0 and 3.0. For mechanical valve replacement, the INR should be 2.5-3.5.

Maximal exercise treadmill stress test demonstrating functional capacity equivalent to completion of Stage III (9 minutes) of the 12-lead Bruce protocol. If beta-blockers, calcium channel blockers, or digitalis-type medications are being taken to inhibit heart rate response, it may be necessary to discontinue the drugs for 48 hours before testing in order to attain adequate heart rate. Consult with your physician before discontinuing medication. Submit report(s) and original or legible copies of tracings.

24-hour Holter monitor with representative tracings.

Current 2D, M-mode, and Doppler echocardiogram, including the video of the study.

SPECT nuclear cardiology studies using technetium and/or thallium 201 or cardiolite may be required if clinically indicated or if the ECG exercise stress test is equivocal, positive for ischemia, or indicative of ventricular dysfunction or other significant abnormalities.

AASI for Single Mechanical or Tissue Valve Replacement, Valvuloplasty and Mitral and Aortic Insufficiency

After initial certification by FAA staff doctors, subsequent renewals for valve replacement qualify for AME Assisted Special Issuance (AASI), a process that provides examiners the ability to issue an airman medical certificate to an applicant who has a medical condition that is disqualifying under 14 CFR Part 67. The authorization letter received from FAA, granted in accordance with part 67 (14 CFR Part 67.401), is accompanied by attachments that specify what information the treating physician(s) must provide for the renewal issuance. Examiners may issue renewal of an airman medical certificate if the applicant provides the following:

An authorization granted by the FAA

A current status report performed within 90 days that must include all the required follow-up items and studies as listed in the authorization letter and that confirms absence of recurrent disease